A new study from Columbia University suggests that removing the bursa during shoulder surgery may be impairing the success of rotator cuff surgery. The bursa is a thin tissue that plays a role in helping the shoulder heal, and its removal during surgery may have unintended consequences. Surgeons commonly remove the bursa during shoulder surgery, but the full implications of this practice are not fully understood.
Rotator cuff injuries are common, with wear and tear from repetitive motions often leading to damage. More than 500,000 rotator cuff surgeries are performed each year in the United States to repair these injuries, but these surgeries can fail due to poor healing between the tendon and bone. This failure rate ranges from one in five surgeries in young patients to as high as 94% in elderly patients with large tears.
The bursa is thought to provide cushioning between tendons and bones, but recent studies suggest it may have other biological roles, including promoting healing of injuries to the tendons in the shoulder. In a study on rats with repaired rotator cuff injuries, researchers found that removal of the bursa impaired the mechanical properties of an uninjured tendon and deteriorated bone quality. The presence of the bursa protected the uninjured tendon and bone, suggesting a beneficial role in rotator cuff health.
In the damaged tendon, the bursa promoted an inflammatory response and activated wound healing genes. The researchers also explored the possibility of using the bursa as a drug delivery depot to improve healing. Injecting corticosteroid microspheres into the bursa of rats after tendon injury showed promising results, indicating that the bursa could be therapeutically targeted to improve rotator cuff healing. Further research is needed to fully understand the potential of using the bursa for drug delivery in rotator cuff surgeries.
Overall, the study findings suggest that surgeons should carefully consider the consequences of removing the bursa during shoulder surgery. The bursa plays a beneficial role in rotator cuff health, contrary to the historical view that it may be detrimental. By retaining the bursa, surgeons may be able to prevent or delay the progression of pathology in the shoulder, leading to better outcomes for patients undergoing rotator cuff surgery. Further research is ongoing to investigate the long-term effects and potential therapeutic applications of the bursa in improving rotator cuff healing.
